You are waiting to undergo a state-of-the-art skin cancer removal procedure called "Mohs Micrographic Surgery" at The Center for Dermatology, Cosmetic and Laser Surgery by our Mohs Surgeon, Dr. Matthew B. Quan. The procedure was invented in the 1930's by Fredrick Mohs, M.D., at The University of Wisconsin to remove complicated skin cancers unresponsive to traditional therapies. To be a Mohs Surgeon in the American College of Mohs Micrographic Surgery and Cutaneous Oncology a special fellowship is required. In addition to the Mohs Surgeon, who serves as the Surgeon and the Pathologist, a certified histotechnologist is employed to process the tissue specimen.
You have been referred for Mohs Surgery in our surgical suite because your skin cancer requires special treatment.
Several effective methods are available for the treatment of skin cancer. The treatment choice is dependent on several factors including size, previous treatment, location, and tumor type. Mohs Surgery is indicated for basal and squamous cell skin cancers and provides the highest cure rate for both primary (first time) cancers and recurrent (previously treated but then came back) cancers. Mohs Surgery is a complex procedure combining surgical excision with immediate microscopic examination of the entire tissue specimen margin by frozen tissue processing techniques right in the office. It consists of five steps:
- Numbing the skin with a local anesthetic called Lidocaine.
- Surgical removal of a thin layer of skin containing the tumor in the shape of a bowl.
- Dividing the specimen into slices that are numbered, mapped, color coded, sectioned and stained in the lab.
- Examination by the Mohs Surgeon of each section under the microscope to determine if the entire tumor has been removed.
- If the tumor is removed completely, the skin defect is repaired. If the specimen shows tumor remaining, then steps 1 through 4 are repeated until the skin is free of cancer.
The Mohs Surgery technique allows us to examine 100% of the surgical margin and, if tumor is still present, pinpoint the precise location of the leftover cancer. This allows us to selectively remove another layer of skin from the area only where the cancer remains. This minimizes the normal skin that is removed. Since some skin cancers removed with Mohs Surgery are complicated, multiple stages may be necessary. Examination of each stage takes up to 60 minutes. If multiple stages are taken, the Mohs procedure can take up a good part of the day, so you must reserve the entire day for this surgery.
How To Prepare For Your Surgery
Do not take any aspirin, aspirin-containing, or vitamin E products for at least 14 days prior to you surgery. These thin the blood. If your physician put you on aspirin, be sure to check with him/her before stopping it. You may take Tylenol for a headache or pain.
If you have an artificial joint or valve, or metal pins or screws, inside of you, or you need antibiotics before dental procedures or other surgery, then you will need to take antibiotics 1 hour before coming to the office for your Mohs Surgery. Please tell us if you require such antibiotics so we can prescribe them for you.
Take all of your routine medications as you normally would EXCEPT any of your medications that we have told you to stop (i.e. Aspirin, Coumadin or Vitamin E). If you are taking Coumadin(a blood thinner) you will need to check with the doctor who prescribed it for you, to make sure you are allowed to stop taking it.
You also might want to bring some reading material to help pass the time.
We ask that a friend or relative accompany you home after surgery. It might make the time pass more quickly to have someone to talk to. Also, driving during the first few hours after surgery is discouraged since a bulky dressing at the surgery site may obscure your visionor mobility.
Eat a normal breakfast or lunch on the day of the surgery. You may bring your own lunch or snacks.
Do not drink any alcoholic beverages for 2 days before the surgery.
Wear comfortable dark clothing. Be sure your shirt buttons in the front and does not slip over your head. No one-piece outfits.
Take a shower and wash your hair on the morning of your surgery. Do not apply makeup if your surgery is being done on your face.
Be certain not to schedule any important or special events or out-of-town trips for several weeks after the surgery.
We recommend no exercise or heavy lifting for one to two weeks after the surgery. It will be important for you to rest and take it easy.
Please be prepared to have a scar! Unfortunately, skin cancers are often larger than seen by the naked eye and, as a result, the scars are frequently much larger than expected. Our primary goal is to remove all the cancer the day you come in. After it is totally removed, every effort will be made to leave you with as excellent a cosmetic result as possible.
What To Expect The Day Of Surgery
Please be prepared to WAIT! Mohs Surgery is a complex process and, due to its nature and the nature of surgery, unexpected "delays" and "adjusting" are commonplace. We appreciate your understanding.
After you arrive in the office and are checked in, you will be taken to our surgical suite where the Mohs procedure will be performed. Before the start of the procedure, feel free to ask questions. Please let us know if there is anything we can do to make you feel more comfortable.
First, Dr. Quan will use a small needle to inject a local anesthetic to numb the entire tumor area. If additional injections are needed later, these are usually painless or much less painful.
After the area is numb, Dr. Quan will remove a thin layer of skin affected by the cancer. This is called Stage I and represents the first layer of skin that is mapped, divided, and color-coded. An electric needle is used to stop any bleeding. The wound is bandaged.
Over the next hour, Dr. Quan and the histotechnologist are busy processing the tissue and examining the stained tissue sections with the microscope.
If the microscopic examination shows that there is still skin cancer left, Dr. Quan will repeat the procedure. Additional tissue is removed only from those areas still affected by skin cancer.
Further stages are removed until all the cancer is gone. The average number of stages is 2 or 3.
Once the skin cancer has been completely removed, the defect may be repaired. Usually the wound can be closed in a linear fashion with stitches. This turns the circular hole in the skin into a straight line (scar). In other cases, a more complex procedure known as a flap or graft may be required, or the hole may be left open to heal by itself. This decision will depend on the wound size, depth and location. Dr. Quan will discuss this with you once the cancer is fully removed. If the wound is stitched up, the stitches are removed typically one or two weeks later.
If the cancer is on the face, it is advisable to keep your head elevated while sleeping or resting with an extra pillow or two for one or two weeks after the surgery. This reduces swelling. Sometimes, if the cancer is anywhere remotely near the eye, you may get one or two "black eyes" after the procedure; the worst day being about three days later. No treatment is necessary. Although cold compresses may be helpful. Although in most cases the wound looks well after the stitches are removed, often it may take weeks to months of careful wound care to the scar site. Therefore, we ask that you be certain not to plan any important social events or out-of-town trips for several weeks following thesurgery.
Informed Consent
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